Orthopaedic Surgery Didactic Session Improves Confidence in Distal Radius Fracture Management by Emergency Medicine Residents.

Audience: This didactic session on distal radius fracture diagnosis and management is designed for Emergency Medicine (EM) residents of all levels.

Introduction: With an incidence of 1,130 upper extremity injuries per 100,000 persons per year,1 distal radius fractures (DRFs) are the most common adult fracture, representing 17.5% of all fractures.2-4 Yet, many emergency medicine residents feel unprepared to manage DRFs independently upon graduation.5 The standard management of a fracture in the ED setting consists of identifying any urgent aspects of the fracture, controlling pain, performing a reduction if necessary, and applying a splint.6 Poor reduction or splinting techniques can lead to serious complications, including acute carpal tunnel or compartment syndrome, development of severe burns and rarely, amputation.6-8 Though it is common for emergency medicine (EM) resident trainees working in academic institutions to have regular access to orthopaedic surgery consultation, many will go on to practice in community settings or departments without access to full-time orthopaedic coverage. It is essential for EM residents to be familiar with DRF diagnosis and management, including closed reduction and splinting. We seek to create a toolbox for managing upper extremity fractures, with the overall purpose of improving orthopaedic care in the ED setting.

Educational objectives: By the end of this didactic session, learners should be able to: 1) assess DRF displacement on pre-reduction radiography and formulate reduction strategies, 2) perform a closed reduction of a DRF, 3) apply a safe and appropriate plaster splint to patient with a DRF and assess the patient's neurovascular status, 4) assess DRF post-reduction radiography for relative fracture alignment, and 5) understand appropriate follow-up and necessary return precautions.

Educational methods: Learners attended a didactic session led by orthopaedic surgery residents which included a faculty-approved lecture on DRFs and hands-on skills workshop on reducing the fractures and effectively applying plaster splints.

Research methods: Prior to the educational session, participants completed a pre-workshop survey assessing current practices and baseline confidence regarding DRF management. Self-confidence levels for each skill were measured using a Likert scale from 0 (least confident) to 100 (most confident). Confidence levels were re-assessed immediately after the didactic session and three months later.

Results: Nineteen emergency medicine (EM) residents (n=12, 63% female) across three class years (n=9, 47% PGY 1; n=6, 32% PGY 2; n=4, 21% PGY 3) completed the pre-workshop survey, and 15 residents participated in the didactic session and completed follow-up surveys. Fourteen (75%) EM residents reported reducing DRFs on their own (without an orthopaedic consult) less than half of the time. After the workshop, confidence levels increased significantly across all seven domains of DRF management, most notably in applying a plaster splint (+31.9 points, p<0.001), teaching DRF splinting techniques (+37.0 points, p<0.001), and managing DRF care in the ED independently (+34.6 points, p<0.001). These improvements persisted three months later.

Discussion: The didactic session and skills workshop on DRF management were effective in improving EM residents' confidence measures in the short term. The session was well-received by the residents, who unanimously expressed interest in collaboration for future orthopaedic workshops. Further work should replicate this study with a larger sample and develop skills assessments to objectively evaluate learners' abilities in the short and long-term.

Topics: Distal radius fracture, reduction, splinting, collaboration, orthopaedic surgery, orthopaedics, resident education.